1/73. Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child.A 3.7-year-old girl presented with an anterior neck injury followed by progressive subcutaneous emphysema and loss of consciousness. After resuscitation, a laceration on the first tracheal cartilage was closed surgically. As she was extubated one week later, she was found to have right hemiplegia and muteness. MRI showed a T2-bright lesion on the tegmentum of the left midbrain down to the upper pons. Right vertebral angiography disclosed an intimal flap with stenosis at the C3 vertebral level presumably caused by a fracture of the right C3 transverse process later confirmed in a cervical 3D-CT scan. Her muteness lasted for 10 days, after which she began to utter some comprehensible words in a dysarthric fashion. Her neurological deficits showed improvement within 3 months of her admission. Transient mutism after brain stem infarction has not been reported previously. We discuss the anatomical bases for this unusual reversible disorder in the light of previous observations and conclude that bilateral damage to the dentatothalamocortical fibers at the decussation of the superior cerebellar peduncle may have been responsible for her transient mutism.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
2/73. Healing of the intimal dissection of the internal thoracic artery graft.We report healing of the intimal dissection of an internal thoracic artery graft. Triple coronary artery bypass grafting was performed using left internal thoracic artery and saphenous vein grafts. One month after operation, the intimal dissection of the internal thoracic artery graft was clearly visible by coronary angiography; however, after 1 year of only medical treatment consisting of warfarin, ticlopidine, and nitrate, the intimal dissection was undetectable by coronary angiography.- - - - - - - - - - ranking = 7keywords = intima (Clic here for more details about this article) |
3/73. Treatment of a coronary aneurysm with a new polytetrafluoethylene-coated stent: a case report.A 43-year-old man underwent implantation of a PTFE-covered stent to exclude an aneurysm in an aorto-coronary venous bypass graft. A successful aneurysm closure was achieved after high-pressure stent expansion and no intimal hyperplasia was observed within the PTFE-covered stent segment in the angiogram performed 9 months later. The technical characteristics and indications of this new coronary prosthesis are discussed based on the authors' recent experience in 63 patients.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
4/73. Restenosis following carotid endarterectomy--clinical profiles and pathological findings.Restenosis following carotid endarterectomy is not a rare condition. Among 122 endarterectomies we experienced, five restenoses (4.1%) were encountered and treated by the second surgery. The present report clarifies the clinical profiles and pathological findings of restenosis following carotid endarterectomy. Mean age of restenosis group (59 years old) was not significantly different from the group without restenosis (62 years old). Average duration between the first endarterectomy and the second surgery was 17 months (8-30 months). Initial symptoms were transient ischemic attack in three sides, minor stroke in one side, and asymptomatic in one. Degree of stenosis was tight (> or = 90%) in two and moderate (70-89%) in three. It is interesting to note that no ulcer was noted in the first endarterectomy specimen. At surgery for restenosis, two cases had symptoms and another two cases were asymptomatic, though all had neck bruits. Four of five lesions were treated by short venous graft from common carotid artery to distal internal carotid artery and another lesion was treated by second endarterectomy and Dacron patch graft. pathology was studied in four and all showed myointimal hyperplasia. Three of four restenosis tissues showed mutant form p53 by immunohistochemistry. The present study indicates that restenosis following carotid endarterectomy is not a rare status. Short venous bypass across the stenotic portion is the treatment of choice. Monoclonal growth of smooth muscle with mutant form p53 might be related to the restenosis.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
5/73. Persistent patent pseudolumen of ruptured dissecting aneurysm involving the posterior inferior cerebellar artery after proximal clipping.In the majority of cases of ruptured vertebral artery dissecting aneurysm after proximal clipping, the dissected pseudolumen persists for a very short time, probably because re-entry from the pseudolumen is minimal. Recent reports have indicated a high risk of rebleeding of dissecting aneurysms involving the posterior inferior cerebellar artery (pica) after proximal clipping, probably due to excessive retrograde flow from the distal vertebral artery into both the pica and the pseudolumen. We describe an extremely rare case of ruptured dissecting aneurysm involving the pica with persistent patent pseudolumen after proximal clipping. The present case was assumed to have developed a moderate retrograde flow just sufficient to maintain the patent pseudolumen in the chronic stage. Neointimal formation is suggested to be a possible mechanism by which the pseudolumen is stabilized for a very long period.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
6/73. Enlargement of ulcer-like projections after repair of acute type A aortic dissection.We treated two cases of enlargement of ulcer-like projections in the descending thoracic aorta, which were recognized after emergency graft replacement from the ascending aorta to the aortic arch for acute type A aortic dissection. The intimal tear, which was near the left subclavian artery, was resected during the initial operation. Graft replacement of the descending thoracic aorta was successful.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
7/73. Pulmonary hypertension associated with pulmonary occlusive vasculopathy after allogeneic bone marrow transplantation.BACKGROUND: Pulmonary vasculature abnormalities, including pulmonary veno-occlusive disease, have been demonstrated in marrow allograft recipients. However, it is often difficult to make a correct diagnosis of pulmonary lesions. methods: An open lung biopsy was performed on a patient who developed severe pulmonary hypertension after bone marrow transplantation for T-cell lymphoma. RESULTS: An open lung biopsy specimen demonstrated pulmonary arterial occlusion due to intimal fibrosis and veno-occlusion. The most striking alteration was partial to complete occlusion of the small arteries by fibrous proliferation of the intima. CONCLUSION: High-dose preparative chemotherapy and radiation before transplantation are thought to have contributed to the development of vasculopathy in this patient, because arterial occlusion by intimal fibrosis and atypical veno-occlusion are often associated with lung injury due to chemoradiation. An open lung biopsy is essential for diagnosing pulmonary vascular disease presenting signs compatible with posttransplantation pulmonary hypertension.- - - - - - - - - - ranking = 3keywords = intima (Clic here for more details about this article) |
8/73. Spontaneous graft closure in anomalous origin of the left coronary artery.Several reports of successful correction of anomalous origin of the left coronary artery from the pulmonary artery utilizing a graft to the ascending aorta have demonstrated the feasibility of this procedure. The patient described in this report developed proved delayed occlusion of the saphenous vein graft with a fatal outcome. This was a result of intimal fibrous hyperplasia identical to that seen in adults following the placement of the saphenous vein bypass graft for treatment of atherosclerotic coronary disease.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
9/73. Intraoperative balloon angioplasty for aortic coarctation after Norwood operation.We report intraoperative balloon angioplasty for recurrent aortic coarctation in hypoplastic left heart syndrome. After bidirectional Glenn anastomosis, balloon angioplasty was performed via ascending aorta. pressure gradient across the coarctation decreased from 45 to 8 mm Hg. Intravascular ultrasound revealed successful splits of thickened intima without any extensive dissection. Intraoperative balloon angioplasty is a safe and favorable procedure for hypoplastic left heart syndrome because balloon inflation before bidirectional Glenn anastomosis could induce serious ventricular collapse or arrhythmias.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
10/73. Aneurysmal degeneration and late rupture of an aortorenal vein graft: case report, review of the literature, and implications for conduit selection.The saphenous vein is among the most commonly used conduits for renal artery revascularization in adults. Vein grafts are more durable in the renal artery bed than in coronary and peripheral beds, and mechanisms of potential graft failure vary. Coronary vein grafts often fail because of atherosclerotic degeneration, whereas lower extremity grafts fail because of intimal hyperplasia or progression of underlying disease. In contrast, renal vein grafts may dilate over time but seldom fail. This may relate to the distinct hemodynamic environment of the renal bed with low-resistance, high-velocity blood flow. However, frank aneurysmal degeneration of renal vein grafts is rare with only a single report of rupture in the literature. We report an additional case of rupture of a late graft aneurysm and review the literature and our own experience with renal revascularization to underscore the rarity of this serious complication. The saphenous vein for aortorenal bypass grafting continues to be a favorable conduit for renal revascularization. Long-term duplex ultrasound scanning follow-up is recommended to survey the reconstructed artery and perhaps more important, to evaluate progression of subclinical disease in the contralateral renal artery.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
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